Public access CPR and AED device

ABSTRACT

A system for resuscitation of a heart attack victim. The system includes CPR device which compresses the victim&#39;s chest, a defibrillator which may be used to defibrillate the patient, and an identification system for identifying the person operating the system. Depending on the identity of the operator, the system permits varying degrees of access to components and enablement of the functions of the various subsystems.

[0001] This application is a continuation of U.S. application Ser. No.10/160,870 filed Jun. 1, 2002, now U.S. Pat. No. 6,690,969, which is acontinuation of U.S. application Ser. No. 09/263,656 filed Mar. 5, 1999,now U.S. Pat. No. 6,398,744.

FIELD OF THE INVENTION

[0002] This invention relates to the resuscitation of cardiac arrestvictims.

BACKGROUND OF THE INVENTION

[0003] Cardiopulmonary resuscitation (CPR) is a well known and valuablemethod of first aid. CPR is used to resuscitate people who have sufferedfrom cardiac arrest after heart attack, electric shock, chest injury andmany other causes. During cardiac arrest, the heart stops pumping blood,and a person suffering cardiac arrest will soon suffer brain damage fromlack of blood supply to the brain. Thus, CPR requires repetitive chestcompression to squeeze the heart and the thoracic cavity to pump bloodthrough the body. Very often, the victim is not breathing, and mouth tomouth artificial respiration or a bag valve mask is used to supply airto the lungs while the chest compression pumps blood through the body.The methods of providing oxygenated airflow to the lungs are referred toas ventilation.

[0004] It has been widely noted that CPR and chest compression can savecardiac arrest victims, especially when applied immediately aftercardiac arrest. Chest compression requires that the person providingchest compression repetitively push down on the sternum of the victim at80-100 compressions per minute. CPR and closed chest compression can beused anywhere, wherever the cardiac arrest victim is stricken. In thefield, away from the hospital, CPR may be accomplished by ill-trainedby-standers or highly trained paramedics and ambulance personnel.

[0005] When a first aid provider performs chest compression well, bloodflow in the body is typically about 25-30% of normal blood flow. This isenough blood flow to prevent brain damage. However, when chestcompression is required for long periods of time, it is difficult if notimpossible to maintain adequate compression of the heart and rib cage.Even experienced paramedics cannot maintain adequate chest compressionfor more than a few minutes. Hightower, et al., Decay In Quality OfChest Compressions Over Time, 26 Ann. Emerg. Med. 300 (September 1995).Thus, long periods of CPR, when required, are not often successful atsustaining or reviving the victim. At the same time, it appears that, ifchest compression could be adequately maintained, cardiac arrest victimscould be sustained for extended periods of time. Occasional reports ofextended CPR efforts (45-90 minutes) have been reported, with thevictims eventually being saved by coronary bypass surgery. See Tovar, etal., Successful Myocardial Revascularization and Neurologic Recovery, 22Texas Heart J. 271 (1995).

[0006] In efforts to provide better blood flow and increase theeffectiveness of bystander resuscitation efforts, chest compressiondevices capable of performing the tasks of the basic CPR procedure havebeen proposed and used. Our own modular CPR device, described in ourU.S. Pat. Nos. 6,142,962 and 6,066,106, provide for circumferentialchest compression performed by a battery operated motor and clutchassembly. The chest compressions are accomplished automatically afterinstallation and initialization of the system. The devices are designedfor use by both untrained and trained operators, so that they may beused on patients as quickly as possible. It is intended that anybystander recognizing a fallen patient will be able to gain access to anearby device, install the device, and initiate the operation of thedevice to commence chest compression and patient monitoring.

[0007] Our CPR devices described-in our U.S. Pat. Nos. 6,142,962 and6,066,106 also incorporate an automatic emergency defibrillator.Defibrillation is a well known technique for restoring normal heartrhythm to a patient who is in cardiac arrest due to ventricularfibrillation or ventricular tachycardia. It involves attachingelectrodes to the patient and applying a large electrical shock to thepatient. Defibrillation can resuscitate a large class of cardiac arrestpatients, and its success is enhanced by application of the shock earlyin the resuscitation effort. A minute or so of chest compression alsoenhances the effectiveness of defibrillation shocks in reviving thepatient.

[0008] Recently, automatic emergency defibrillators (AED) have beeninstalled in controlled areas such as airplanes, where the presence oftrained operators and secure access to the AED can be maintained. Thepractice of installing AED's in controlled areas is sometimes referredto as Public Access Defibrillation. However, laws in most jurisdictionsforbid installation of the devices without maintenance of a number oftrained operators in the controlled area and oversight of the programmaintenance by a doctor.

[0009] Our U.S. Pat. No. 6,213,960 provides a control system foroperating an automatic defibrillator and an automatic chest compressiondevice in coordination with each other to enhance the effectiveness ofthe resuscitation. The device also provides electro-stimulation forelectroventilation, electro-counterpulsion, abdominal binding andglottic closure, all coordinated with the chest compression device toeffect electro-stimulation at various points in the compression cycle.

SUMMARY

[0010] The public access CPR and AED device described below is intendedto be installed in public areas where access is readily available tobystanders, first responders, EMT's and doctors. However, it is notnecessary, nor desirable, to permit full access of the device to theentire range of people who might desire or require access since someusers will not be properly trained to supervise the device's operation.To control and thus permit the optimal degree of access to the system, atiered access system is used to control physical access and functionalenablement of the system. Physical access means access to the deviceitself, and/or access to certain accessories used for patient treatmentin conjunction with the device that may be stored in the device or withthe device (ET tubes, venous access kits, laryngoscopes, drugs, etc.).Functional enablement refers to the system allowing operation of certainfunctions, such as chest compression, alteration of setpoints,application of defibrillating shock, etc. Thus, the system must be told(or determine for itself) that it is permitted to initiate a therapeuticmode before it does so. One mechanism for differentiating the type ofuser accessing the device is through the identification subsystemsensors, since, for example, only trained personnel are “key holders”(as described in further detail below in reference to FIG. 2.)

[0011] The intended models of use for these systems include installationin hospitals and ambulances, and widespread installation in public areassuch as workplaces, shopping centers, athletic facilities and stadiums,and even in homes of patients with an identified high risk of cardiacarrest. The devices may be installed in hospitals and ambulances withoutconcern about the level of training for the expected user, because theexpected user will be a highly trained operator such as a physician,nurse or emergency medical technician. These trained users can beexpected or required to have the expertise necessary to supervise andadminister all phases of the resuscitation protocol. However, becauseinstallation and activation within minutes of the onset of cardiacarrest is critical to saving a patient's life, it is desirable to allowthe device to be deployed by untrained bystanders or minimally trainedfirst responders, and permit trained first responders and untrainedbystanders to operate the device in safe modes. The system reservesphysical access to advanced equipment and/or functional enablement ofadvanced modes which may present some danger to the patient for trainedfirst responders. The system may have additional treatment modules, suchas drug delivery equipment, that should only be used by expertoperators, and the system prohibits access to these modules to all butidentified expert operators. Trained first responders and expertoperators may identify themselves to the system through the use ofaccess cards, identification numbers or access codes, while the systemmay assume lack of identification indicates use by an untrainedbystander. In all instances of use, the system initiates communicationswith a remote medical center, where operator identity may be confirmedand the level of access and enablement of the system may be adjustedremotely.

BRIEF DESCRIPTION OF THE DRAWINGS

[0012]FIG. 1 is diagram of a chest compression, ventilation anddefibrillation device controlled by the tiered access system.

[0013]FIG. 2 is a block diagram of the system for controlling access toa resuscitation device.

[0014]FIGS. 3A and 3B show the system flow chart for system of FIG. 2,with details of the tiered access system.

[0015]FIG. 4 shows the device of FIG. 1 installed in a locked mountingdevice.

DETAILED DESCRIPTION OF THE INVENTIONS

[0016]FIG. 1 shows the Public Access CPR and AED Device mounted on apatient 1 and ready for use. The chest compression subsystem 2 comprisesthe motor box 3, the belt cartridge 4, and the compression belt 5 withleft and right portions 5L and 5R. The belt is fastened around thepatient with fasteners 6 (which may be buckles, Velcro™ hook and loopfasteners or other fasteners with sensors to sense when the belt isfastened). Ventilation electrodes 7L and 7R are mounted on the belts inthe area of the lower chest and placed bilaterally over the diaphragm.Bipolar electrodes 8L and 8R (or electrode pairs) may also be placed onthe neck, bilaterally, to stimulate the phrenic nerve which coursesdownwardly through the neck. Defibrillation electrodes 9R and 9L areplaced on the right and left sides of the chest and they may also belocated below the patient, on the spine between the shoulder blades, andon the center of the chest, respectively. These electrodes are used forestablishing the electrical contact needed for EKG sensing, and also fordefibrillating the patient. Counterpulsion electrodes 10 i and 10 s areplaced on the skin over the abdominal or rectus muscles, with a line ofpositive electrodes placed in the superior position and a line of groundelectrodes placed in the inferior position. Glottic control electrodesare disposed on an electrode patch 11 placed on the neck along thetracheoesophageal groove.

[0017] The control box 12 houses a computer system that controls thevarious functions of the device. The computer system controls operationof the chest compression device, acquisition of signals from variousfeedback mechanisms such as the EKG electrodes, and application ofstimulating or defibrillation pulses to the electrodes. (Commerciallyavailable sensors, electrodes and EKG analysis systems such as theForeRunner™ AED sold by HP Heartstream can be used as the basis for thecardioverting subsystem). The computer system may also control operationof additional therapeutic modules, such as drug injection modules. Thecomputer system also controls the communications subsystem 13 used toinitiate and maintain communication with a remote medical facility. Thecommunications subsystem may include a telephone handset, keypad anddisplay.

[0018] An identification subsystem 14 is operably connected to thecontrol box 12 and/or communication subsystem, 13 and may include a keycard reader 15 for reading an encoded card, a keyboard or touchpad 16for entry of an access code or personal identification number, and abiometric sensor 17 for reading a biometric parameter of the user suchas a fingerprint. A secure device enclosure 18 is connected to thecontrol box through electronic cable 19, and is locked or unlocked ascontrolled by the computer system. The secure device enclosure may houseventilation equipment such as bag valve masks or ventilation tubes,medication used in the ACLS protocol, invasive devices such asintravenous needles (and, if desired, defibrillation electrodes). Thesystem also includes diagnostic devices for sensing EKG, pulse,respiration and temperature. Thus, the system includes several means forresuscitation of the patient and several means for sensing biologicalparameters of the patient to diagnose the patient. Any number of medicaldevices, including resuscitation devices and diagnostic devices, may beemployed in the system.

[0019] The Public Access CPR and AED Device illustrated in FIG. 1compresses the chest to force blood circulation; stimulates thepatient's nerves to cause an inhaling contraction of the diaphragm, theintercostal muscles, and the abdominal muscles; stimulates the patient'sabdominal muscles to cause binding or counterpulsile contraction of theabdomen; and delivers defibrillating electrical shock to the patient.The computer system controls all of these therapeutic modes, subject toinitialization and enablement of these actions by the operator or remotemedical center.

[0020] The device is intended to be installed in public areas whereaccess is readily available to bystanders, first responders, EMT's anddoctors. The device should be quickly installed on a heart attackvictim, prior to the arrival of specially trained users. However, it isnot necessary, nor desirable, to permit full access of the device to theentire range of people who might desire or require access since someusers will not be properly trained to supervise the device's operation.To control and thus permit the optimal degree of access to the system, atiered access system is used to control physical access and functionalenablement of the system. Physical access means access to the deviceitself, and/or access to certain accessories used for patient treatmentin conjunction with the device that may be stored in the device or withthe device (ET tubes, venous access kits, laryngoscopes, drugs, etc.).Functional enablement refers to the system allowing operation of certainfunctions, such as chest compression, alteration of setpoints,application of defibrillating shock, etc. The system must be told (ordetermine for itself) that it is permitted to initiate a therapeuticmode before it does so. One mechanism for differentiating the type ofuser accessing the device is through the identification subsystemsensors, since, for example, only trained personnel are “key holders”(as described in further detail below in reference to FIG. 3.)

[0021] The system utilizes a remote medical facility (not shown). Themedical facility may maintain a database that stores user identificationinformation, an indication of the user's permitted level of access, andthe user's authentication information.

[0022]FIG. 2 illustrates the overall system functions. Theinitialization module 20 waits for user input that indicates the systemis in use and must begin operation. Once the device is accessed, theinitialization module operates to start several modules. The systemestablishes communications with a remote medical facility through thecommunications module 21. During use, the system will accept useridentification information, as indicated by the user identificationinput module 22. The system analyzes the user's identification, inputfrom a remote medical facility if available, in the identificationprocessing module 23. The system utilizes the user's identity todetermine whether or not a user will be allowed physical access to thedevice, as indicated by the physical access module 24. The system alsouses the user's identity to determine which of the various capabilitiesof the system will be enabled, as indicated by the functional enablementmodule 25. The remote input module 26 receives input from a remotemedical facility, and this input can be used to control theresuscitation devices.

[0023]FIGS. 3A and 3B show the system flow chart for system of FIG. 2,with details of the tiered access system. The initialization module 20achieves the system's ready state. The device is intended to be storedfor extended periods of time before it is used, thus making itimpractical to keep the computerized components fully operational at alltimes and the system in constant communication with a remote medicalfacility. Thus, whenever the system is used, it must be started up sothat the various subsystems can achieve a ready state. The system can bedesigned to start up as any computerized system, either from acompletely un-powered condition or from a sleep mode, in which thecomputer control module is always energized to the extent necessary tosense an input (comparable to a lap-top computer in sleep mode).

[0024] The initialization module monitors the system housing to sense aunit access attempt. This is also known as an initiating event, such asthe removal of the device from a storage location, disconnection from acharging battery holder, insertion of a key card into the card reader,or operation of any startup sequence initiated by the operator (pushinga button, entering an access code, etc). FIGS. 3A and 3B illustrates anembodiment of the system which uses insertion of a key card (for trainedusers) as one initiating event, and a push button or telephone pick up(for bystanders) as an alternate initiating event.

[0025] Upon recognition of the initiating event, in addition to thesteps taken in the CPR protocol as illustrated in our prior patents, theinitialization module establishes a communication link with a remotemedical facility. Via this link, the initialization module communicatesthe activation attempt to the medical facility, and differentiates tothe medical facility the type of initiating event (physical removal ofthe device versus insertion of a key card). In this way, the medicalfacility is made aware of the device activation as well as the type ofuser activating the device.

[0026] The initialization module also communicates an encrypted deviceID to the remote medical facility such that the remote medical facilitywill know where to send trained EMTs. The initialization module alsooptionally activates an associated video camera system.

[0027] The user identification module 22 seeks input from theidentification subsystem 14. The identification subsystem may include akey card reader 15, an access code system (touchpad) 16, or mechanicalkey system (not shown). In this manner, operators of different traininglevels may be issued a key card, security code, or actual key, so thatthese trained operators can identify themselves to the system as “keyholders”. Several levels of access may be provided by use of several“keys,” each issued to different levels of trained users and eachaccepted by the system as identification of a different level of traineduser. This provides for the “tiered” access system.

[0028] The identification subsystem 14 may also include an optionalbiometric sensor 17 for use in coordination with a key card reader,using both the biometric information on the key card and the sensedbiometric information to ensure the user's identity, and using thetraining information on the key card to determine the appropriate accessto the device.

[0029] The identification subsystem 14 is mounted on the resuscitationdevice, and while the resuscitation device is mounted in the wall mount,it is also detachably wired to the wall mount (through releasablecommunications cables and connectors) so that it can communicate withany electronic or communications equipment housed within the wall mount.The identification subsystem is thereby carried with the resuscitationdevice after the system has permitted the device to be detached from thewall mount.

[0030] The user identification module monitors the system waiting tosense an input from the identification subsystem 14. If the useridentification module senses a key card, access code, or mechanical key,the module reads, for example, the key card identification andcommunicates to the remote medical facility this information for thenext step of determining the physical access level attainable.

[0031] If the user identification module does not sense a key card,access code, mechanical key, or if for some reason the localidentification fails, redundancy and backup of the identification systemis provided such that the user is interrogated by the remote medicalfacility to ensure that the device is intended to be used for a cardiacarrest victim. This may be necessary when a trained first responder orexpert user is available to supervise and operate the device, but cannotbe identified by the device due to loss of an access card or failure ofthe identification devices. If local identification fails, thecommunications subsystem 13 (not shown) may be used to communicate theidentification information or backup identification information to theremote medical facility, and access can be granted by remote input intothe identification module. The backup information may be personalidentifying numbers of the operator, such as a unique access code or asocial security number. Thus the user identification module, uponfailure of identification, will respond to an access control signal fromthe remote medical facility. If the interrogation fails to confirmproper use, the device remains locked so that it remains available foran actual emergency. The system is reset and self check performed inanticipation of an actual emergency.

[0032] A concern with such a device is that it might be used byunauthorized users wrongfully in possession of a key. To avoid thispossibility, the system can require redundant identificationinformation, which can be provided through biometric sensors. Trainedusers are issued a magnetic strip card which stores the users traininglevel and access level, along with additional authenticatinginformation. At the very least, the authenticating information may be apersonal identification number or PIN, which a user may enter throughthe keyboard after inserting the access card into the card reader.However, since some trained users may not use the system often enough toensure that they will remember a PIN, a biometric sensor such as afingerprint reader may be used. Trained users are issued a keycomprising an access card capable of storing biometric information suchas the user's fingerprint (retinal scan information, voice print, orother biometric data can be used). The purpose of the biometric data isto provide authentication with information that is guaranteed to bereadily available to the user, and cannot be forgotten or lost. Theaccess card may be a credit card sized card with a magnetic strip whichcontains the users identification, an indication of the users traininglevel, and a representation of the users fingerprint, or uniquefingerprint information. These access cards are then used in conjunctionwith an identification module which includes a card reader anddetermines the card users training level and recorded fingerprintinformation, and also includes a fingerprint reader which reads theusers fingerprint and compares it with the recorded fingerprintinformation to ensure that the user is actually the trained userpreviously identified by a system oversight facility. The systemoversight facility can issue the access cards after training the users,thereby maintaining control of the training and the access card. Usingthis system, there is no need for communication with the systemoversight facility, and no need to refer to an extensive database ofuser identification information or biometric information, so that thematerial requirements for the identification module are eased. Biometricsensors which read and verify card-stored fingerprints are commerciallyavailable.

[0033] As illustrated in FIG. 3A, the user identification module 22refers to the physical access module 24 after the identification processhas been completed. If the user is identified as a Level 1 bystander orLevel 2 first responder, the physical access module 24 permits access tothe device such that it allows the device to be removed from the wallmount (through operation of relay operated locks or otherelectro-mechanical locking devices). The device may then be installed onthe patient by the bystander. If the user is identified as a level 3expert operator or EMT, the physical access module may permit access toadditional components, such as ACLS supplies (needles/IV/ET tubes)stored within the device or in the wall mount system (again, throughoperation of electro-mechanical locks such as electrically operatedlatches). If the user is identified as a level 4 paramedic or doctor,the physical access module may permit access to drugs. If the user isidentified as a level 0 maintenance technician, the system may permitaccess to the internal workings of the device, such as mechanicalcomponents and computer systems to permit service access.

[0034] In a large portion of the expected uses, the resuscitation systemwill be removed from the wall mount by a first operator, typically abystander. Shortly thereafter, EMT's should arrive on scene. While it isadvantageous to the patient to be fitted with the resuscitation deviceand sensing devices immediately, with the assistance of any availableperson, it is not necessarily advantageous to permit the system tooperate treatment devices which apply power to the body until moreexperienced operators such as EMT's arrive on scene. Thus, the useridentification module is designed so that operators arriving on sceneafter deployment of the system can enter their identificationinformation, and the system will functionally enable power emittingmedical devices and permit physical access to advanced equipment. WhenEMT's do arrive, communications with a remote medical facility shouldalready be established by the system through the initialization module.The EMT can enter his identification information, which can be processedby the onboard operating system or by the remote medical facility, andeither the onboard operating system or the remote medical facility canfunctionally enable power applying devices. The system may be redundantin its enablement capabilities, allowing enablement by either the remotemedical facility or by the local operator (of appropriate level), sothat enablement in proper situations is ensured by one or the other(i.e., in case of a communications failure with the remote medicalfacility).

[0035] The physical access module also provides for redundancy andbackup where, after the EMT, paramedic, or doctor have arrived on thescene after an initial bystander access, the module monitors the deviceto sense a key card reader insertion or other access such that the nextlevel of care may be achieved. Essentially, the physical access moduleis in constant contact with the user identification module to performthis system update.

[0036] After the physical access module completes its task (or inparallel to the operation of the physical access module), the systemrefers to the functional enablement module 25 illustrated in FIG. 3B.This module enables different parts of the control system depending onthe access level indicated by the identification module. We haveillustrated in the flow chart an initial assignment of functional accesswhich may change according to experience, medical indications and legalrequirements at the time the device is used.

[0037] Where the user is identified as a level 1 bystander, indicatingan untrained user, the system will permit deployment of the device anduse of the communications and sensing modules. For example, the systemwill allow the entire device to be removed from a storage base intowhich it is normally locked when not in use so that it may betransported to a patient. The system will not allow compression,defibrillation, electro-stimulation, access to stored medication, etc.when the user is identified as a level 1 bystander. This is representedby Level 1 in FIG. 3B.

[0038] Where the user is identified as a level 2 trained firstresponder, the system will permit use of the communications modules,sensing modules, compression modules and electro-stimulation modules.The system permits all the actions of the level 1 (bystander level), andadditionally enables compression. This is identified as Level 2 in FIG.3B. Compression may be enabled in an automatic mode, meaning that itcommences as soon as proper installation of the compression belt isverified by the systems or it may be enabled such that compressioncommences when the user directs the system to commence compression withuser input from the keypad.

[0039] Where the user is identifies as a level 3 expert operator or EMT,all the previous modules will be enabled and other more sensitivemodules such as the defibrillation module may be enabled, and sensitiveadjuncts such as the drug injection devices and invasive sensing devicesmay be unlocked or enabled. The precise allocation of therapeuticmodules to different access levels may vary as experience with thedevice indicates that therapeutic modules require more or less stringentcontrols. This is labeled as Level 3 in FIG. 3B.

[0040] Finally, where the user is identified as a doctor, the systemenables all therapeutic modes (such as ACLS drug delivery, pacing,etc.), and allows the doctor to adjust system thresholds and parameters(such as maximum chest compression, compression rate, defibrillationpower, etc.) This is labeled as Level 4 in the flow chart.

[0041] All levels provide for a dispatch of appropriate emergencypersonnel. All levels provide a communication, instruct and monitordeployment function. All levels provide for monitoring and transmittingof physiological parameters (heartbeat, EKG, blood pressure, etc) to theremote medical facility. Finally, all levels provide communicationmodules so that the system may transmit the physiological data to theremote medical facility. It should be appreciated that the assignment ofphysical access and functional enablement levels to the differentclasses of users may vary considerably, and that therapeutic devices maybe added to the system in addition to the devices used to illustrate theinvention. For example, we expect that operation of the chestcompression device will prove to have little adverse effect if appliedto a patient who is not suffering from cardiac arrest, so thatapplication of chest compression may be permitted when the device isused by a level 1 bystander.

[0042] The remote input module allows the remote medical facility toremain in the loop and control the operation in the field. The remotemedical facility receives data via the functional access module. Theremote facility may then analyze the data and send remote controlcommunication to the field. For example, the remote medical facility maytransmit signals via the feedback module to the device to enable chestcompression or other features, as medically indicated by the sensedbiological parameters provided by the functional access module.

[0043]FIG. 4 shows the resuscitation device configured in a wall mount.The resuscitation device is mounted and locked into a base 27 which isinstalled in an accessible place where it is likely to be needed, suchas in a shopping mall, workplace, theater or stadium. The wall mountedbase preferably has a charger for continuously charging the batteriesrequired by the resuscitation system and telephone connections if thesystem is to be implemented through cordless telephone communicationbetween the device and the remote medical facility (with the cordlesstelephone base incorporated into the base). The motor box 3,communications module 13, identification module 14 rest in the base, andare locked in the base when the system is not in use. The card reader 15and telephone handset remain accessible to any potential user, so thatthe system can be initiated whenever desired. The chest compressionsubsystem and secure device box remain closed and locked withelectro-mechanical locks. Thus, the device is secured in the base untilneeded. When needed, the device can be removed from the base in theseveral ways described above. A trained first responder with an accesscard may insert the card into the card reader, and this will unlock theentire device from the base so that it can be carried to a heart attackvictim. An untrained bystander can initiate communications with theremote medical facility with the telephone handset, and uponinterrogation and confirmation of the bystanders need for the device,the device may be unlocked through the transmission of an appropriatesignal from the remote medical facility.

[0044] While the preferred embodiments of the devices and methods havebeen described in reference to the environment in which they weredeveloped, they are merely illustrative of the principles of theinventions. Other embodiments and configurations may be devised withoutdeparting from the spirit of the inventions and the scope of theappended claims.

We claim:
 1. A system for use on a patient, wherein said system requiresan operator for deployment on the patient, and the system may beoperated by various classes of operators assigned varying levels ofaccess, said system comprising: a chest compression device;defibrillation electrodes for supplying a defibrillating shock to thepatient; identification means for determining the level of access of anoperator of the system; and a computer operably connected to theidentification means, said computer programmed to permit the compressiondevice to be placed on the patient and permit operation of thecompression device when the compression device is placed on the patientregardless of the operator's permitted level of access; wherein thecomputer is further programmed to prohibit delivery of a shock throughthe defibrillation electrodes for operators having a first permittedlevel of access and to allow delivery of a shock through thedefibrillation electrodes for operators having a second permitted levelof access.
 2. A medical treatment system for treatment of a patient,wherein said medical treatment system is intended to be used in anenvironment wherein the device may be removed from a secure storagedevice and deployed upon the patient by a first operator pending arrivalof a second operator, said medical treatment system comprising: aplurality of medical devices; means for controlling physical access tothe plurality of medical devices; means for controlling functionalenablement of a medical device included within the plurality of medicaldevices; means for determining the level of access of the first operatorand permitting physical access to a medical device by the first operatorwhile prohibiting functional enablement of the medical device to thefirst operator; means for determining the level of access of the secondoperator and permitting functional enablement of a medical deviceincluded within the plurality of medical devices upon determining thelevel of access of the second operator; wherein the means forcontrolling physical access is operable to permit physical access to amedical device included within the plurality of medical devicesdepending upon the level of access of the first operator; and the meansfor controlling functional enablement is operable to permit functionalenablement of a medical device included within the plurality of medicaldevices depending upon the level of access of the second operator. 3.The system of claim 2, wherein the means for controlling physical accessto a medical device comprises a computer programmed to operateelectro-mechanical locks securing the medical devices to hold or releasethe medical devices in response to level of access information inputtedby the first or second operator.
 4. The system of claim 2, wherein themeans for controlling functional enablement to a medical devicecomprises a computer programmed to permit operation of the plurality ofmedical devices in response to level of access information inputted bythe first or second operator.
 5. The system of claim 2 wherein the meansfor determining the level of access of the first operator comprises acommunication system in communication with a remote medical facility,and means for receiving a signal from the remote medical facility whichcauses the means for controlling physical access to hold or release themedical devices in response the signal from the remote medical facility.6. The system of claim 2 wherein the means for determining the level ofaccess of the second operator comprises an access card provided to thesecond operator, level of access information stored on the access card,and a card reader coupled to the system, wherein said card reader iscapable of reading the access card and transmitting level of accessinformation to the means for controlling functional enablement.
 7. Thesystem of claim 2 wherein at least one of the medical devices amongstthe plurality of medical devices is capable of both diagnosis andtreatment of a condition of the patient, and the controller permits thefirst operator to operate the at least one medical device in adiagnostic mode while prohibiting the first operator from operating theat least one medical device in a treatment mode.
 8. The system of claim2 wherein the at least one medical device is an automatic externaldefibrillator, and the controller permits access to the automaticexternal defibrillator to the first operator, thereby allowing the firstoperator to install the automatic external defibrillator on the patient,but the system prohibits the first operator from operating the automaticexternal defibrillator to apply defibrillating shock to the patient, andthe system permits the second operator to operate the automatic externaldefibrillator to apply defibrillating shock to the patient.
 9. A medicaltreatment system for treatment of a patient, wherein said medicaltreatment system is intended to be used in an environment wherein thedevice may be removed from a secure storage device and deployed upon thepatient by any one of a number of potential operators, said medicaltreatment system comprising; an automatic external defibrillator; meansfor controlling physical access to the automatic external defibrillator;means for controlling functional enablement of the automatic externaldefibrillator; means for determining the level of access of a particularoperator attempting to use the medical treatment system and permittingphysical access to the automatic external defibrillator based on thelevel of access of the particular operator; wherein the means forcontrolling physical access is operable to permit physical access to theautomatic external defibrillator depending upon the level of access ofthe particular operator; and the means for controlling functionalenablement is operable to permit or prohibit functional enablement ofthe automatic external defibrillator depending upon the level of accessof the particular operator.